Jonathan Goldberg, CIO, Arkansas Children’s Hospital, Chapter 1

When asked why they chose to pursue a new role, leaders often say they needed a challenge. Although sometimes it can be code for another reason, it certainly seems fitting in Jonathan Goldberg’s case. A year and a half ago, he left St. Peter’s Health Partners in upstate New York to serve as CIO at Arkansas Children’s Hospital, the only facility of its kind in a state that ranks 49th overall in children’s health. While that might have some people running for the hills, Goldberg views it as a “huge opportunity to make a difference.” In this interview, he talks about the learning curve in transitioning to pediatric care, the challenge in juggling multiple big projects at the same time, the innovative work his team is doing with telemedicine, and how they’re leveraging technology to stay lean.

Not only are we going to implement with Epic, but we actually have to get the whole hospital outfitted with the infrastructure needed for them to function.

There may be an opportunity where, after the implementation, the staff size realistically may shrink. We’re hoping, whether it’s through attrition or whether we have other needs, that we can move people around to other projects.

A year and a half or two years from now when we’re looking at our needs, we want some flexibility to be able to make good decisions. We didn’t want anybody to say, ‘I can’t believe I moved from a job I had for 15 years to join the Epic team, and now you’re saying you don’t need me or my skill set anymore.’

We had a significant strategy around management of labor, and with API, it brought labor analytics to the table, and that capability is something that was very important to us. And so while we didn’t need to do it at the same time, it was important enough that we thought it made sense to do it in combination with the change of our payroll system.

Gamble: Hi Jonathan, thanks so much for taking some time to speak with us today.

Goldberg: My pleasure. Always fun to talk to you.

Gamble: I think the best way to start is with some basic information about Arkansas Children’s Hospital — what’s the size of the organization, the number of physicians, and things like that.

Goldberg: Sure. We’re based in Little Rock, which is smack in the middle of the state of Arkansas, and we actually provide care for the entire state. We’re the only children’s hospital within the state of Arkansas, and we have a little over 350 licensed beds at this point. We are building a second hospital in northwest Arkansas, also known as the backyard of Wal-Mart. Arkansas is somewhat of a rural state, but the two population centers are Little Rock and what we call Northwest, which is Bentonville, Springdale-Rogers and Fayetteville, with Fayetteville being the home of the University of Arkansas.

As our population grew, we realized a lot of those folks were coming down here for care to Little Rock, which is about a 3 or 3.5-hour drive, or we were transporting people via helicopters and ambulances.

It’s been a planning exercise, but we actually have that hospital under construction now. It’s a small hospital, but it’ll be one that’ll enable us to keep some of the folks that need more general medical care near their hometown.

Also, we are affiliated with the University of Arkansas, and our physicians — we have about 600 — are all University of Arkansas Medical Sciences employees. And we are a teaching hospital. Typically, we have about 150 to 200 residents here at any given time as well.

Gamble: Okay, and now for the IT department, what’s the approximate size?

Goldberg: We’ve beefed up a little bit recently due to some of the projects we’re working on. But when I came here a little over a year ago, we were just shy of about 150.

Gamble: And I assume one of those big projects is migrating to Epic.

Goldberg: That is correct. We are moving to Epic. We made that decision a little over a year ago. One thing we had to deal with in terms of timing, because it’s somewhat of a fast-moving project, is that we’re building a new hospital. We wanted to open the hospital with a new system, and so that determined our timelines somewhat. The new hospital opens in January of 2018, not too far away.

We were still aiming for that January 2018 opening, but we’re backing into it. We’re going to go live with Epic here on the Little Rock campus and our ambulatory centers in November of this year, which is seven months away.

Gamble: Okay, so not too far away. What phase would you say that it’s in right now?

Goldberg: We just wrapped up our build phase. We just finished the majority of what they call the workflow build and we started the testing phase, which will go through into July when we start picking up with training. Of course training will take us up to October, and then hence, go-live. We’ll bring everything up one day, big bang — the hospital and our clinics — and then we’ll have a couple of months reprieve before we bring Northwest Arkansas up.

At the same time, we had a multi-prong strategy. Of course, the timing didn’t necessarily work in the favor of those who actually had to implement, but we’re also implementing Workday as our ERP Suite. We’ve just wrapped up and went live with Strata for our decision support, and we went live on time and attendance with API. We had all those projects including the new hospital all happening at the same time, which has been a bit of a challenge for us.

Gamble: Sure, that’s a lot going on. Now, will those projects be to the point where you can take some of the resources off them and focus more on Epic?

Goldberg: No. Since all the projects started at the same time, they are finishing staggered. None of them are fully finished, and there may be a few small projects that will still have to wrap up. Unfortunately, trying to move them on to the Epic project is a little more difficult because we’ve had to fully populate Epic project and have it moving forward already. But there are a lot of other things we still need to do. Will they play a part in integration tasks? That remains to be seen. We’re evaluating PACS Systems right now for replacement, and obviously we have a new hospital. Not only are we going to implement with Epic, but we actually have to get the whole hospital outfitted with the infrastructure needed for them to function.

We have some activities around in our population health area. We’re building a state-wide clinically-integrated network, which will include as many pediatricians as we can get to join, which is a significant amount throughout the state. That CIN started about six or nine months ago, and we’re in the midst of starting that rollout now of assembling the folks and coming up with a work plan. So there’s never a shortage for work for anybody, even if projects do end.

Gamble: Definitely. You had said you’re beefing up the staff. Is that with full-time positions or more like either consultants or supplemental team members?

Goldberg: We moved a lot of people around. What we’ve done is, the people that supported our legacy systems moved on to the Epic team, and we backfilled them with consultants. Once that system shuts down we won’t need that support mechanism, so we wanted to have our staff stay with us. We did bring people from operations, whether it be pharmacists, some additional nurses, tech, and lab folks onto the project, and they’re certified Epic builders now. We do know that there’s an opportunity once the project is fully up and functional and we’re in a more of a day-to-day state; hopefully we’ll get there at some point. There may be an opportunity where, after the implementation, the staff size realistically may shrink. We’re hoping, whether it’s through attrition or whether we have other needs, that we can move people around to other projects or initiatives.

Some people may elect to go back to operations and that’s okay too, but people signed on to the project. We essentially gave two-year employment contracts to everyone on the team, saying, ‘We’re guaranteeing your employment for two years,’ and then we will revisit it at that point. Certainly, it was only for everybody’s protection and to set the right expectations — not that we hope to lose anybody, but we also don’t know what we don’t know. A year and a half or two years from now when we’re looking at our needs, we want some flexibility to be able to make good decisions. We didn’t want anybody to say, ‘I can’t believe I moved from a job I had for 15 years to join the Epic team, and now you’re saying you don’t need me or my skill set anymore.’ Hopefully, we won’t come to that, but at the same time we need to be prepared for the things that we just didn’t know, being fair to everybody.

Gamble: Right. As far as having all of these projects going on, with Epic, the ERP suite and decision support, did things just fall that way, or was the thinking, ‘we’re going to get this new clinical system in, so let’s get these things up to speed as well?’ What was the thinking there?

Goldberg: What drove the decision to do it all at once?

Gamble: Right.

Goldberg: I equate it to pulling a string on your sleeve to get rid of that one string, and then you just keep pulling that little thread, and before you know it, you have no sleeve left. We’ve been a long-time customer of Meditech and a very good partner of theirs since 1985. As I mentioned, we have a significant connectivity to the University of Arkansas Medical Sciences, and they are an Epic customer. There’s a lot of connectivity to us in terms of care and physicians and training. So there just seemed to be some community synergy for us to be able to have that linkage.

That was one of the factors that helped drive that decision. We used Meditech for our ERP Suite, for cost accounting and for clinical systems. Once we made the decision to move away from Meditech, all the other ones had to fall into place from a replacement standpoint since, obviously Epic couldn’t do our new ERP Suite. We had a significant strategy around management of labor, and with API, it brought labor analytics to the table, and that capability is something that was very important to us. And so while we didn’t need to do it at the same time, it was important enough that we thought it made sense to do it in combination with the change of our payroll system, which Workday handles.